This Newsletter Brought to You by the Physicians and Staff of the Center for Primary Care


Fun in the Sun

Make Plans Now for a Safe Summer


In the Southeast, hot, sunny weather often arrives suddenly and long before the official beginning of summer. This means warm-weather activities, such as gardening, swimming, and boating, can kick into high gear practically overnight. Before summer sneaks up on you and your family, take a few minutes to review some important summer safety rules.


Avoid sun exposure between 10 a.m. and 4 p.m., when the suns damaging ultraviolet rays are strongest.

If you cant avoid the sun, protect your skin in other ways: wear clothing that covers your arms and legs, a wide-brimmed hat that shades your face, UV protective sunglasses that fully cover your eyes, and lip balm and sunscreen with a sun protection factor (SPF) of at least 15.

Remember to protect areas that are easily overlooked, such as your scalp, your ears, the back of your neck, and your feet.

Remember that childrens and babies skin is much more sensitive to sun than that of adults, so be especially cautious about protecting them from exposure.

Reapply sunscreen every two hours, even on cloudy days. Reapply even more often when sweating or doing water-related activities, such as swimming.

Avoid reflective surfaces, such as water and light sand, which can reflect up to 85% of the suns rays, nearly doubling your exposure.

Remember that clouds do not block UV rays. This means you can get just as much of a burn on a cloudy day as a sunny one.

If being tan is important to you, trade your time in the sun and tanning bed for a tube of good bronzer and save your skin from the premature aging and cancer sun exposure can cause.




Never swim alone or in unsupervised locations, even if youre an adult who is an accomplished swimmer.

Always have a responsible adult closely supervise young children who are swimming, playing, or even bathing in water.

Teach children to always swim with a buddy.

Never drink alcohol before or while swimming, boating, or water skiing, and especially while supervising children.

If you dont know how to swim, take lessons. Instruction is beneficial to children and adults alike.

Keep your pool clean to prevent the spread of infectious diseases. Never swallow pool, lake, or river water.

When boating, make sure everyone is wearing a properly secured flotation device.

To avoid being one of the thousands of people who drown or are injured or killed in boating accidents each year, stay alert and use common-sense precautions this summer.


Source: CDC Highlights Summer Health and Safety Tips. CDC Office of Communication, Media Relations Press Release, June 2003 (website); Protect Yourself from the Sun, American Academy of Dermatology Public Resources, 2003 (website).


CPC-Evans To Offer

In-Office Rx Service


The Evans office of Center for Primary Care will soon be opening CPC-RediRx, an in-office pharmacy for certain prescription medications. Patients receiving prescriptions for these medications from their CPC doctor will be able to fill them at the Evans office pharmacy, a convenient alternative to retail pharmacies.

As plans for CPC-RediRx are finalized, information will be posted in the Evans office waiting room, or you can ask your doctor for more details.


Construction Update

Big Changes Are Underway

at Central and in North Augusta


CPC is growing to serve you better! The new North Augusta Health Center and the CPC-Central expansion are both progressing on schedule and will be in full use later this spring.

CPC Welcomes Dr. Mishra

The Center for Primary Care is pleased to welcome S. Lynn Mishra, M.D., as our 14th physician and the first on staff at the North Augusta Health Center (NAHC). She began seeing patients at CPCs temporary North Augusta office on Knox Avenue in January, and will move to the new facility on Hugh Street when it is completed in May.

Born in New Dehli, India, and raised in Southwestern Pennsylvania, Dr. Mishra graduated from the University of South Carolina in Columbia in 1987 and from USC-Columbia School of Medicine in 1993. She completed her internship and residency in Family Medicine at Flower Hospital in Sylvania, Ohio.

Prior to joining CPC, Dr. Mishra was in private practice in Wilson, N.C, and was a clinical assistant professor at the University of North Carolina School of Medicine in Chapel Hill, East Carolina University Brody School of Medicine in Greenville, and Bowman Gray School of Medicine in Winston-Salem, N.C. She was also a physician and medical director at Stantonsburg Medical Center, Wilson Memorial Hospital in Stantonsburg, NC.

Dr. Mishra and her three children, Noah and Alex, both 11 years old, and Natalie, 7, are happy to be making their home in North Augusta.

To schedule an appointment with Dr. Mishra, call CPC-North Augusta at 279-6800 between 8:30 a.m. and 5 p.m. Monday through Friday.


Medicare Rx Benefit Program Designed to Reduce Drug Costs

In response to the rapidly rising cost of prescribed drugs, a drug benefit program for the Medicare-eligible population was signed into law in late 2003. Originally projected to cost $409.8 billion in the coming decade, the new program represents the largest expansion of Medicare since its inception in 1965. Estimates in the 2005 federal budget project an even higher total cost: $530 billion, or about a third more than originally thought.

The purpose of the program is to reduce how much Medicare-eligible Americans have to pay out-of-pocket for prescription drugs. The rising cost of these medications affects everyone – in 2002, the average prescription drug expenditures for all Americans grew by more than 15%, representing over 10% of all personal healthcare expenditures for that year but it can be especially burdensome for elderly people with limited and/or fixed income and minimal to no health coverage other than Medicare.

All Medicare-eligible Americans automatically qualify for the prescription drug benefit program, regardless of whether they receive care through a health plan or other payment system. However, level of coverage will be based on each individuals (or couples) financial status. Those with lower income and fewer assets – approximately 14 million people or one third of eligible elderly people – will reap the greatest financial benefits.

Under the program, beneficiaries will receive more than their out-of-pocket expenses only if their annual prescription drug costs exceed $810 (average). For many older Americans, this minimum will not be a factor. Based on Congressional Budget Office (CBO) estimates, the average drug expense among eligible people will be $3,155 in 2006, so it is likely that a great number of elderly people will benefit from the program. Those with low income and few assets will gain the most: more generous, no-gap coverage and very low cost-sharing requirements.

Because the program will not begin until 2006, a temporary Medicare-approved drug-benefit (discount card) program has been created as a stop-gap measure to ease the financial burden of prescription drugs for the Medicare population in the interim. Beneficiaries can enroll in the temporary program when it goes into effect this spring. More than one third of eligible people currently have no coverage, and those who enroll can expect to save 10% to 15% of their overall drug cost. This temporary program will end in 2006, when the prescription drug benefit law goes into effect.

Below are some highlights of the new prescription drug benefit program from the American Association of Retired Persons (AARP):

Interim discount card: beginning spring 2004, beneficiaries can purchase a card for about $30, good for an estimated 10% to 15% off prescription drug costs.

Interim low-income assistance: People with a 2004 income of less than $12,390 (couples $16,720) will each get $600 a year credited to their card.

Coverage choice: Beginning January 2006, beneficiaries can choose to (a) stay in traditional Medicare, a current Medicare HMO, or a retiree plan without signing up for the drug benefit; (b) stay in Medicare and enroll in a stand-along drug plan; or (c) enroll in a private health plan that offers drug coverage and Medicare health services.

Drug benefit: Enrollees will have an annual deductible of $250, estimated premium of $35 a month (may vary depending on coverage chosen) and a 25% copayment of drug costs up to a maximum of $2,250 annually. After that, enrollees pay all drug costs up to $3,600 out of pocket. At this point, catastrophic coverage begins and enrollees pay either 5% of prescription costs or per-prescription copayments of $2 (generic) or $5 (name brand), whichever is greater.

Dual-eligible subsidies: People eligible for both Medicare and Medicaid will have no deductible, no premium, and per-prescription copayments of $1 (generic) and $3 (brand name).

Other low-income subsidies: People with a 2006 income of less than $13,000 (couples $17,600) and assets of less than $6,000 (couples $9,000) will have no premium, no deductible and no gap in coverage. Out-of-pocket per-prescription costs will be $2 (generic), $5 (name brand), and nothing above the catastrophic limit. A sliding scale will be used to determine out-of-pocket costs for people with slightly higher incomes.

Medicare Part B changes: There will be a moderately higher deductible with built-in annual increases, the premium will be linked to income beginning in 2007, and people with higher incomes will pay more on a sliding scale.

For more detailed information on how the Medicare drug benefits program will affect you, including a formula for helping you calculate your benefits, visit AARPs website (


Source: Health Policy Report, New England Journal of Medicine, Vol. 350, No. 8, February 19, 2004; AARP Bulletin Online: Prescription Drugs, What Does the New Medicare Drug Benefit Mean for You? (

Bone Scan Measures Bone Health, Predicts Disease Risk

As little as 50 years ago, a persons first indication of osteoporosis might have been stooped posture or perhaps a fractured bone, but by the time these signs were evident, there was very little that could be done to stop or reverse the damage.

Much more is known today about when and how bone mass is built, and there are accurate ways to measure current bone density, predict future bone loss, and monitor the effectiveness of treatment. For those who already have osteoporosis, there are also medications available to slow or even reverse bone loss that occurs as a natural part of the aging process and from other causes, such as long-term smoking, steroid use, or calcium deficiency.

Bone mass refers to the density and strength of bones. The human body builds bone mass at a high rate during childhood and adolescence and then levels off somewhat until around age 30. At this point, bones begin to break down, or lose density, faster than new bone is formed. If allowed to progress, this loss of bone mass eventually results in dangerously weak and brittle bones, often leading to fractures of the wrist, spine and hip, progressive curving of the spine, loss of height, pain, physical disability, and death.

Some risk factors cannot be changed: for example, heredity (eg, having a small frame, being Caucasian or Asian, or having a family history of osteoporosis, especially in a close relative); or medical (eg, long-term use of medications such as steroids and anticonvulsants, having certain chronic medical conditions, having anorexia nervosa, and for women, being estrogen-deficient). However, you can change the numerous behavioral and lifestyle risk factors that impact bone health, including low intake of calcium and vitamin D, chronic inactivity, cigarette smoking, and excessive use of alcohol. If you are at risk of developing osteoporosis, wise lifestyle choices are the path to prevention.

How can you find out if you are losing bone mass without waiting until visible signs of bone loss begin to appear? By acquainting yourself with the risk factors for

osteoporosis, including age and gender, and working with your family physician to develop your personal risk profile. Your doctor may determine that you should have your bone density measured. A bone scan can reveal osteoporosis before fractures occur, predict your chances of fracturing in the future, determine your rate of bone loss and, if you are being treated for osteoporosis, determine how effective the treatment is by comparative retesting at regular intervals.

The method CPC physicians prescribe for their patients is DEXA, a full-body scan that measures bone density in several parts of your bone structure. It is like a regular X-ray, in that it is quick, painless, and accurate. A mobile DEXA unit makes scheduled visits to CPC offices. Scans are performed by appointment only, and if there is a medical indication for the scan, Medicare and many insurances cover the test. If you are not sure if DEXA is covered by your health plan, you should check with your insurance provider prior to undergoing the test. According to the National Osteoporosis Foundation, Medicare covers bone mass density (BMD) testing for individuals aged 65 and older with specific risk factors for osteoporosis and permits retesting every 2 years.

If your bone scan reveals that your bone health is not as good as it should be, your doctor may recommend a regimen to improve your bone density or prevent further loss, including dietary changes, calcium supplementation, weight-bearing exercise, other lifestyle changes, and/or medications.

If you think you have osteoporosis or are at high risk for the disease, see your family physician to determine what you can do to improve your bone health.


Source: National Osteoporosis Foundation website (